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Overview

You don’t have to accept occasional bladder leakage as
another side effect of menopause or aging. In many cases, there are things you
can do to stop and even prevent urinary incontinence.

Urinary incontinence (UI) is also known as “loss of bladder
control” or “involuntary urinary leakage.” Millions of women experience it, and
the frequency of UI tends to increase as you get older. The loss of control can
be very minor. For example, you might only leak a few drops of urine when you
laugh, exercise, cough, or pick up heavy objects. Or you might experience a
sudden urge to urinate and be unable to keep it in before reaching the restroom,
resulting in an accident.

You can experience UI throughout your life, but most
episodes are the result of pressure or stress on the muscles that help you hold
or pass urine. Hormone changes can also affect your muscle strength in the
pelvic region. Therefore, UI is more common in women who are pregnant, giving
birth, or going through menopause.

Estrogen is a hormone that helps regulate your menstruation.
It may protect against heart disease and slow bone loss. It also helps keep your
bladder and urethra healthy and functioning properly. As you near menopause,
your estrogen levels begin dropping. This lack of estrogen may cause your
pelvic muscles to weaken. They may no longer be able to control your bladder as
they did before. As your estrogen levels continue to drop throughout and after menopause,
your UI symptoms may become worse.

Causes
of Urinary Incontinence

A few different types of urinary incontinence are associated
with menopause. These include:

Stress Incontinence

The most common kind of bladder control problem in older
women is stress incontinence. Weakened muscles can’t hold back urine when you
cough, exercise, sneeze, laugh, or lift something heavy. The result can be a
small leakage of urine or a complete loss of control. This type of incontinence
is most often caused by physical changes that result from pregnancy,
childbirth, or menopause.

Urge Incontinence

When your bladder muscles squeeze incorrectly or lose the
ability to relax, you may feel a constant urge to urinate, even when your
bladder is empty. You may also experience leaking of urine or loss of control.
This is sometimes called an “overactive bladder.”

Overflow incontinence

When your bladder
does not empty fully, this type of UI can show as continuous urine dribbling. You
can have a weak urinary stream, feel like urinating at night (nocturia), and
increased urinary hesitancy. This can be caused by underactivity of the bladder
muscle.

Understanding
Your Risk

Menopause isn’t the only cause of bladder control problems.
If you have menopause along with one of the following conditions, your risk of
developing UI increases.

Drinking Alcohol or Caffeine

Beverages with alcohol or caffeine fill your bladder
quickly, causing you to urinate more often.

Infections

Infections of your urinary tract or bladder may cause
temporary UI. When the infection is cleared, your UI will likely resolve or
improve.

Nerve Damage

Nerve damage can interrupt signals from your bladder to your
brain so you don’t experience the urge to urinate. This can negatively impact
your ability to control urination.

Certain Medications

UI can be a side effect of some medicines, such as diuretics
or steroids.

Constipation

Chronic, or long-term, constipation can affect your bladder
control. It can also weaken your pelvic floor muscles, making it harder to hold
in urine.

Being Overweight

Carrying excess weight increases your risk of UI. The extra
weight puts pressure on your bladder. It can cause UI or make it worse.

Treatment
Options

Your treatment for UI depends on several factors, including
the type of incontinence you’re experiencing and what is causing your UI. Your
doctor might start by suggesting lifestyle changes. For example, they might
encourage you to:

cut back on your caffeine and alcohol
consumption

gradually retrain your bladder to hold more
urine by only urinating at certain preplanned times of the day

Kegel exercises involve squeezing and relaxing the muscles
in your pelvic and genital areas to strengthen them. This may help you develop
better bladder control.

Your doctor may also recommend more involved treatment
options, especially if they don’t think that lifestyle changes are helping.
These treatment options are described below.

Medications

Certain medication may help reduce your symptoms and treat
some types of UI. For example, your doctor may prescribe anticholinergics
to calm your bladder if it’s overactive. They may prescribe Mirabegron
(Myrbetriq), a special type of medication called a beta-3 adrenergic
receptor agonist, to increase the amount of urine your bladder can hold. Topic
estrogen products may also help to tone your urethra and vaginal areas.

Nerve Stimulation

Electrical stimulation of your pelvic muscles may help your
regain control of your bladder if your UI is related to nerve impairment.

Devices

A number of devices are available to treat women with UI. A
pessary is the most commonly used device for the treatment of stress
incontinence. It’s a stiff ring that’s inserted into your vagina to help
reposition your urethra in order to reduce leakage. Your doctor may also
prescribe a urethral insert, a small disposable device that you can insert into
your urethra to plug leakage.

Biofeedback

You can work with a therapist to better understand how your
body works. In biofeedback, a wire is connected to an electrical patch over
your bladder and urethral muscles. It sends signals to a monitor, which alerts
you when your muscles are contracting. By learning when your muscles contract,
you may be able to gain better control over them.

Surgery

Surgery to repair and lift your bladder into a better
position is often the last resort for UI treatment. It’s considered for people
who can’t be helped by other forms of treatment.

Long-Term
Outlook

Many types of UI are temporary or improve with treatment.
However, in some cases, your UI may be permanent or difficult to treat.

Even if your UI is permanent, you can take steps to better
improve your management of your symptoms. For example, you can check your local
drugstore for absorbent pads and protective undergarments for adults with UI.
Most of these products are thin and easy to wear under your clothes, without
anyone noticing. There’s no reason you can’t enjoy an active and confident life
with UI.

Speak with your doctor to learn more about your condition,
treatment options, and outlook.